Hodges' Model: Welcome to the QUAD: January 2010

- learn about the conceptual framework Hodges' model. A tool that can help integrate HEALTH and SOCIAL CARE, INFORMATICS and EDUCATION. The model is situated, facilitates person-centredness, integrated - holistic care and reflective practice. A new site using Drupal is an ongoing aim - the creation of a reflective workbench. Email: h2cmng @ yahoo.co.uk Welcome

Sunday, January 31, 2010

International Leprosy Day

Fighting for a Just Cause
Sunday 31 January 2010

How would you respond if, because of a disease,
your family no longer wanted you to live at home?
How would you feel if, because of a disease,
your husband or wife wanted a divorce?
What would you say if you lost your job
because of an illness that had no impact on your ability to carry out your work?
What would you do if your children were no longer allowed to go to school
because of your ill health or disability?

These situations may sound remarkable, unbelievable even, and yet these are real situations, faced by real people everyday. They happen just because the person has leprosy.

TLM-UK: In 2010 The Leprosy Mission is focusing on Nepal to celebrate World Leprosy Day. At Anandaban hospital, patients not only receive medical care, but staff also help them begin the slow process of emotional healing and release. The hospital's projects include medical treatment and surgery, counselling, education support, housing support and small business loans.

Saturday, January 30, 2010

Kiva: Money isn't everything, but it helps - especially in health

In health care we readily appreciate, but still need reminding of the link between wealth - health and poverty. The Black Report and the review some 25 years later is writ large in many student essays, reports and policy aspirations including the latest Labour government.

What we do forget is economics as a problem not just in peoples health, but in establishing a business. Despite the creativity and innovation an entrepreneur can demonstrate, venture capital companies will say "Great idea! Come back when you've got your first sales". This was noted on this week's The Bottom Line on BBC Radio 4.

If it's a real chicken and egg dilemma for innovators in the UK and developed nations, then imagine how difficult it is in countries like Somalia, Uganda, The Democratic Republic of the Congo, Tajikistan, Senegal, and Tanzania, ...?

For people with the aspirations of starting a business that initial, start-up finance is critical not to developing some 21st century technology prototype, but business ventures that we often take for granted in our developed towns and cities clothes, consmetics, food production and sales.

Kiva.org is a great idea. David my old boss brought them to my attention, but now it's time to hop on board.

If you are new to Kiva there is a short video about how a small loan from people like us can help entrepreneurs gain an opportunity they might not otherwise have.

A Fistful Of Dollars: The Story of a Kiva.org Loan from Kieran Ball on Vimeo.
Kivaworld provides a world map so you can readily understand the scope of Kiva and the basics of the way it operates: fund raising, funded, in repayment, paid.

Health and medicine feature in the projects and in the groups of lending teams which you can also join. There are other agencies who ally microfinance with health protection. Health and microfinance already boast a prolonged debate and literature.

I am joining the Kiva community this weekend. Microfinance can make a huge difference to individual lives and now Kiva and its worldwide supporters are creating their own records as revealed on the Kiva blog.

Sometimes it is not enough to just 'maintain a link' as always it's about making a difference. ...
Matt Flannery, Kiva and the Birth of Person-to-Person Microfinance, Innovations, Winter/Spring 2007, 2, 1-2, 31-56. (doi:10.1162/itgg.2007.2.1-2.31).


Wednesday, January 27, 2010

ERCIM News No. 80 Special Theme: "Digital Preservation"

Dear ERCIM News Reader,
ERCIM News No. 80 has just been published at http://ercim-news.ercim.eu/
Special Theme: "Digital Preservation"
- coordinated by Ingeborg Solvberg, Norwegian University of Science and Technology; and Andreas Rauber, Vienna Technical University
- featuring a keynote by Pat Manson, Head of Unit "Cultural Heritage & Technology Enhanced Learning"; European Commission Information Society and Media Directorate-General
Next issue: April 2010 - Special Theme:
"Computational Science/ Scientific Computing: Modelling and Simulation for Research and Industry"
(see call for articles)
Thank you for your interest in ERCIM News.
Feel free to forward this message to others who might be interested.

Best regards,
Peter Kunz

This issue includes:

  • The CARA Approach for Long-Term Preservation and Exploitation of Medical Images and Reports by Hanan Bouzid, et al..
  • Designing a Trusted Distributed Long-Term Archive for Health Records by Frej Drejhammar
  • Providing Web Accessibility for the Visually Impaired by Barbara Leporini, et al..
  • ICASE Project: New Challenges in Computer-Based Assessment by Thibaud Latour and Sandrine Sarre.


is published quarterly by ERCIM, the European Research Consortium for Informatics and Mathematics.
The printed edition will reach about 10,000 readers.
This email alert reaches over 5,000 subscribers.

Advertising in ERCIM News
By advertising in the ERCIM News printed edition, your company or institution will be able to speak to a highly qualified audience: You can reach over 10,000 researchers, scientists and decision makers in the field of information and communication technologies.
For rates and conditions, see http://ercim-news.ercim.eu/advertise

ERCIM - the European Research Consortium for Informatics and Mathematics - aims to foster collaborative work within the European research community and to increase co-operation with European industry. Leading research institutes from twenty European countries are members of ERCIM. ERCIM is the European host of W3C.

Tuesday, January 26, 2010

Midwifery Materials for Haiti - in French/Creole - NEEDED

My source as posted to the GANM and on HIFA 2015 lists:

I am writing the (GANM) community to ask for assistance in gathering online midwifery and nursing materials - in the French or Creole language, for Haiti.

The National Nurse School University and Faculty of Medicine in Haiti has collapsed and they have lost most of their training materials. Dr. Larouche was killed in that collapse - he was teaching an OB course to the midwifery class at the time. I do not know the fate of the nursing/midwifery students, but one can imagine that the outcome is probably not a good one. Dr. Larouche was filling the void left by the untimely death of Madame G.Francoeur last year (she died in an auto accident).

Midwifery in Haiti was just recovering after the sadness of the loss of Mme Francoeur - and the earthquake has now destroyed most everything that they had.

Agnes Jacobs, UNFPA survived and has been emailing from Haiti. She and her colleagues are working to pick up the pieces and try to reconstruct materials for training midwives and nurses in life saving skills.

I am writing to members of the GANM asking for support in finding DIGITAL materials that we can provide to Agnes for the time being. It is VERY hard to get shipments of books and things to Haiti right now, but in the future, I suspect that Agnes will be able to use books, and guides, and computers to rebuild midwifery in Haiti. So eventually we will ask for books and things, but right now it is very hard to get these types of things to her. I know she is not alone, I know that COHI, PAHO, and many others are on the ground. I think the GANM can work with all these others to help in whatever way we can.

Johns Hopkins is sending a team to Haiti, including Dr. Beth Sloand who has been travelling to Haiti with students for over a decade. Beth does not have room to take printed materials, but she can maybe take a packed hard drive or CDs/DVDs that we load with teaching materials. Agnes does have a computer and internet (sporadically) - so I have been discussing with her the potential of sending digital materials which she can start to use right away until printed materials can be provided.

She welcomes health materials in French and or Creole primarily. They should be materials that can *instantly be used to teach midwives and community health workers* - so scientific articles that require interpretation and reconstruction into teaching materials are not what I am asking for at the moment. Right now there are no resources to turn scientific literature into teaching materials. Do you have teaching materials that you would be willing to share?

I would like to ask that people send either direct links to online resources that we can copy down to a CD or send useful teaching materials that we can put on a CD.

Please email them to the GANM or to me (pabbott2 @ son.jhmi.edu)

Regine Marton wrote already directing us to look at Hesperian and the
WHO Reproductive Library (in French). We have the Hesperian material now. The WHO library is helpful.

If you have any quality materials for training of midwives that you would like to donate or direct us to find, please let us know. Please send scientifically sound materials - the last thing that Haiti needs are questionable methods or what we call in the US "hocus-pocus" (unproven claims or "magic").

I hope this makes sense and that the GANM community will come together to help Haiti in a “different” way. I think what we are doing is unique – while of course there are huge needs for emergency care and the like we are looking one step ahead to helping Haiti rebuild its educational infrastructure.

Best Regards,
Patti Abbott
GANM Moderator and "Electronic Midwife"

Nursing and care homes: the new schools 4 basic nursing care?

I do not wish to denigrate the quality of care in nursing homes, as I've blogged previously there are others better placed to do that when needed. In some the nursing care is exemplary and this is evident not just in their inspection rating, but the morale of staff, the reports of relatives and local community plus other indicators - especially when you visit and use your senses. As a nurse you are duty bound to assess the quality of care wherever your practice takes you. In the homes where the care is very poor, there is no escape from that reality. The reality of poor care first hits visitors when they smell the home they have entered. If there is no escape for them - well what then of the residents and staff?

Now an extended and dedicated role for nursing home liaison within community mental health nursing has arrived* and taken root, this must say something about the quality of care in this sector (and not merely suggest a shortage of Consultant Psychiatrists)? Nurse, service managers and commissioners recognise that if they do not preempt the referral torrent (or trickle from some care homes!) then community teams will grind to a stand-still. Care homes need assistance even as private businesses in assuring their holistic competency.

If services do not stem that referral flow as a wave or otherwise, they will in turn become second rate first-aiders with no primary purpose. They will be forced to respond repeatedly to the same client RE-referrals, the same set of disjointed, fractured physical:mental:social health problems presenting in a series of unique individuals. And this is not person-centred care.

What the nursing home liaison role says is that here is one place we can locate the theory-practice gap, a skills gap and a lack of integrated, holistic person-centered care. Mash-ups may be desirable in the virtual world, but in care delivery - is that safe? Too frequently the mash-up of combined physical and mental health problems pass staff by. The problems go unrecognized, they are there: evident, but disguised; due to lack of comprehensive observation, life histories and despite the question and answer sessions at the gates (service interface). However it is described (e.g. single point), the specialisation of community mental health teams into memory assessment, intermediate, community mental health, ... depends on the vibrant management and quality of referrals.

Much is made of nursing homes registered as EMI (Elderly Mentally Ill) and their need for or access to a registered mental health nurse (RMN); but RMNs in turn rely on the ability of more junior staff to observe and accurately report the basic aspects of the resident's physical and mental state. If equity for older people in care is to be achieved, then although the care - nursing home sector is 'private' and a 'business' there must be an accommodation, a partnership when it comes to education and valuing time invested in these homes.

Original image source: Neo - The Matrix http://www.dailygalaxy.com/my_weblog/psychology/

Sunday, January 24, 2010

Hodges' model links in 3D with Topicscape

Roy Grubb (Hong Kong) got in touch recently regards his appreciation of the links resource I have compiled, organise and maintain using Hodges' model. Roy's intention to create a Topicscape in 3-D has now borne fruit. Unfortunately, on my Macbook Firefox fell over trying the link below. I then learned Topicscape runs on Windows PCs only. I look f/w to trying on my (aged) PC, but despite that limitation - this is a great development. Many thanks Roy!!

Here is Roy's post from his site (the larger image below with link is from his initial post):

I wrote about this a couple of weeks ago. Now that I have permission from Peter Jones to use the lists on his pages of links organized according to Hodges’ Health Career Model, I can announce that it is on-line and live in the form of a read-only Topicscape. You can search (just type) and visit the pages (links are in the details panel – just click). Links to the four main pages of links in the Hodges’ Health Career Model site are in the four main topic cones: Intrapersonal, Political, Science, Sociology.

Topicscape image
Give it time to load the Topicscape software first time. Subsequent visits will be much quicker.

For you to fly around and explore this you will need a PC with 3D graphics hardware with an up-to-date graphics driver (requirements here).

There’s a wiki page with some helpful pictures that explain the few things you need to know to get you flying and zooming with the best of them. If you need any help, email me at r dot g at topicscape dot com.


Additional links:

Topicscape - Roy's initial post 'Hodges’ Health Career Model'

Science domain: H2CM (Visualization I & II, VR, Diagrams)

Friday, January 22, 2010

Putting 'care' in a holistic frame

How many frames do you need?

*infocare: care demographics, directories, media, literacies...

care communication,
self care,
care ethics, care philosophy,
emotional care, pastoral (green) care,
therapeutic care, care beliefs,
interpersonal care,
cognitive care, holistic care,
care responsibility, care ecology

emergency care, physical care,
care model, theory, plan,
care assessment, evaluation,
care curricula, intervention,
care process, evidenced care,
intensive care, coronary care,
special care baby unit, *infocare,
nursing care, medical care, health care,
e-care, surgical care

collaborative care,
child care,
personal care, older adult care,
informal care, SOCIAL CARE,
family care, care education,
community care, care community,
residential care,
care dependency,
abusive care, care risks

duty of care, care policy,
care provision, inspection, standards,
care economics, care outcomes,
care legislation, care home,
care contract, care advocacy,
care quality, CARE AID,
care qualification, regulation,
State care, private care,
care insurance, CARE RIGHTS,
care service engagement, prison care

Don't forget the 5th, virtual, spiritual frame?

Where is that?
It is wherever you need it to be. ...

Additional suggestions welcome: h2cmng at yahoo.co.uk

Wednesday, January 20, 2010

Currencies and travel in health and social care

Before the advent of the euro, holidays in Europe were that bit more exotic. Having to buy and adjust to another currency - and not just one - was part of the novelty and fascination of travel.

Health and social care have their own currencies (and yes, read that as there being integration here too!). Most of the currencies are national given the efforts to standardise, with examples such as, length of stay, referral to treatment and more recently in residential care and elsewhere continuing care and its occasionally truculent neighbour 1-to-1. Unfortunately, like land masses, these currencies can also suffer from continental drift.

Dissemination (use in the wild) lack of review and ongoing attention to standards, benchmarks and definitions can see a currency drift in its application and subsequent reporting (affecting perceived utility, value and impact). The value of a currency can be diminished over time as it no longer acts as a unit of difference.

So enjoy your travels, but beware the risks while you vive la difference, especially in your work!

Image source: http://www.artlebedev.com/mandership/77/

Monday, January 18, 2010

Marathon, half-marathons and other journeys

In 1984 a holiday in Athens brought with it the opportunity to visit Marathon. As a cross-country runner at school Marathon had always held a magical place in my mind. It did not disappoint either. Although I did not exactly follow in the footsteps of Pheidippides, the journey from Athens to Marathon was an experience in itself using the bus. And now - is it really 2,500 years since he made that journey?

Now there are many other marathons run the world over.

On the 21st March The Fresh Air Fund in NYC are having a half-marathon. As many of our readers are USA based and perhaps around NYC this may just be the spring (or autumn?) well-being event for you?

Seriously, there are half-marathons the world over. Slightly closer to home for me the Alderney Half Marathon & 10 km Fun Run looks and sounds a great event. Walking or running wherever you are of course just getting out and about helps. In the meantime all the best to the Fresh Air Team, indeed all runners (and cyclists) everywhere!

Sunday, January 17, 2010

Sahana OSS response in Haiti

My source: Community informatics list [ciresearchers]:
Sahana Software Foundation
Haiti Earthquake Response
Status Report #1
January 17, 2010 00:00 UTC

The Sahana Software Foundation and the Sahana community responded with a massive voluntary effort immediately following the earthquake that has devastated the poor country of Haiti. Working around the clock, we have set up a hosted instance of Sahana (the first deployment of SahanaPy following a disaster!) on a public website that is already filling gaps in the information management requirements of the massive relief operation.

Major Accomplishments

We have a Haiti 2010 Sahana Disaster Response Portal - a live and active website up at http://haiti.sahanafoundation.org which contains a feeds from many of the relief agencies and links to Sahana modules that are actively being used to help coordinate the relief effort.

We have a Sahana Haiti wiki page where we are tracking all of our and others' activites at: http://wiki.sahana.lk/doku.php/haiti:start

We have a requirements page where we record all the modification, configurations, and changes to Sahana based on the mission requirements at: http://wiki.sahana.lk/doku.php/haiti:requirements

See - https://sahanafoundation.org/products/eden/

The Haiti 2010 Sahana Disaster Response Portal provides the following functionality:

1. An Organization Registry - serves to track organizations and offices working on the ground in Haiti. Organizations are encouraged to self-register and report their office locations - alternatively, individual organization office or lists of offices can be e-mailed to haiti-orgs AT googlegroups.com and we have volunteers to assist with data entry and to aggregate lists from other sources. We have entered data from pre-disaster lists of organizations working in Haiti available from UN OCHA. We can assume that these organizations will be working on the relief efforts, but expect that most of their office locations will be different as most organizations have been forced to move into tents given that few buildings remain standing and usable in the capital. We are working to validate these lists with the organizations directly.

The site serves up both KML for Google Earth users and GeoRSS for everyone else, and will generate reports of organization activities and the gaps (uncovered sectors by geographic location). This site will hopefully become the main resource for accurate information about the organizations working on the ground, where they are located, and what activities they are engaged in, and the resources in terms of staff and equipment that they have available to them. (Currently, data is admittedly sparse but we expect more details to become available as the coordination efforts take root on the ground). We are coordinating with UN OCHA, Google and others on sources of accurate lists and updates.

What are the gaps in our information collection? We have a large and we think accurate list of organizations, but not much office location information. Without this, it becomes hard to generate data that can be used as a layer in a GIS system. We are encouraging people to report this information - preferably by GPS coordinates, but any location information that we can use to manually geo-reference the office is valuable. We hope to be able to enhance our capabilities such that we can produce polygons showing organization's areas of coverage by sector. Please direct organizations working in Haiti to our site to register their offices and activities!

2. A Missing Persons Registry / Disaster Victim Identification (DVI) Registry - we are working with Google and others on an agreed common standard for the exchange of Missings Persons data using the PFIF standard. The Google site at http://haiticrisis.appspot.com/ is the main aggregator collecting all missing and found persons reports and we are encouraging all people to send data to that site. [We are struggling a little as Google's feed is not fully PFIF compliant and the lack of unique record identifiers makes it more complex to set up true synchronization without the creation of duplicate records. We continue to work with Google on this and hope to have a resolution and solution within the next few hours.] We will also be embedding Google's widget on our site for collecting missing person information. Google will be making their data available via a PFIF feed and we will be importing it into Sahana's Missing Persons registry. From there, Sahana can add value to the simple lists being collected.

In particular, Sahana's Disaster Victims Identification registry - or DVI - which is used to management the handling and tracking and tracing of the deceased, dead bodies and their identification. There is currently no other known application for this and we hope that those working in this area will find Sahana extremely valuable. Sahana will have the ability to cross-reference missing persons information with the identified and unidentified deceased, thus facilitating reconciliation efforts. The Sahana Missing Persons registry has additional physical description information fields and we hope to be able to utilize some of the image matching capabilities available to extend these capabilities further. Organizations interested in utilizing these capabilities (which will not be made open for public use) should contact the Sahana team at
sahana-haiti AT lists.launchpad.net.

Any updated missing persons status information will be pushed back to the main Google repository from Sahana.

3. Situation Mapping - Sahana's site is able to map all of the geo-referenced data within Sahana - primarily the organization data, but we have also manually entered a data layer of hospitals and medical facilities. Sahana has worked with members of the OSGeo community to obtain a fast tiled set of the current imagery being made available by Digital Globe. Sahana is also leveraging the constantly updated set of Open Street Map tiles. These are acting as backdrop for the offices that are being entered as part of the Organization Registry. Other data sources that are ready and available to be leveraged by Sahana and SahanaPy for other deployments include reports from Ushahidi, various point layers from Open Street Map, location names, USGS earthquakes, and locations from GeoNames. We will continue to build out these capabilities further as relevant layers are made available.

Capabilities we are working on:

The following capabilities are in the process of being developed and we expect will soon be available:

4. Request Management: We are working with the US State Department, Ushahidi and some other voluntary efforts on a project to process SMS messages with requests for assistance sent from survivors in Haiti. SMS text messages sent to a short code in Haiti will go into Ushahidi, who will have volunteer translators to add some structure to the message, identifying the sender's name, location (to the extent possible), and category of the message - a missing persons report, a request for assistance, etc. The message will go into a Ushahidi GeoRSS feed that will be captured by Sahana and fed into a simple Request Management system where the requests for assistance (such as "send water" to a certain village or neighborhood) can be made visible to relief organizations working on the ground. Organizations can fulfill or claim requests for handling and message the person back that assistance is coming. (Missing persons information will be captured by Google).

5. Translation: In addition, our translation project is now set up for Kreol and French translation and we may utilize a pool of Kreol-speaking volunteers being set up by the Service Employees International Union (SEIU) to help in these efforts. Interested translators should be directed initially to:
http://translate.hfoss.eu/wiki/Translation to become oriented in the process.

6. Shelter Registry and Disaster Victims Registry: In the coming days, we expect that there will be a requirement to start tracking the location of temporary shelters now being established, and possible registration of the survivors. We will prepare Sahana's existing registries for such purposes, which will produce further consumable data layers as well as additional missing persons reconciliation capabilities.

If you want to help:

We are using the IRC #sahana channel on freenode as our main coordination tool. Join the chat room to volunteer for tasks and someone from our core volunteer team will direct you - this room is actively staffed on a 24x7 basis.

But first, please check out the wiki pages to see what are the current requirements and areas of focus. We have a lot of volunteer Python and PHP programmers already working on the codebase, but we can probably use more. Please review the requirements page in particular to see where you might help.

We also have a large need for non-technical help - particularly for documentation support - user guidelines and instructions in particular - including some nice screenshots.


Finally, we could use help maintaining our own wiki - both the main page and requirements... much of this can be culled from the chat room logs - and helping to update some of the common public repositories of information about similar efforts, such as the crisis commons wiki at
https://crisiscommons.org/, although they are doing a pretty good job at tracking us ourselves.

Remember to add yourself to the wiki as part of team, and what you are doing.


Personally, I have never been a part of such a collaborative and cooperative effort on the part of different organizations to come together and to help each other and to not replicate efforts. The Sahana community has worked closely and constantly with InSTEDD, Ushahidi, haitianquake.com, Google, the Crisis Camp participants, and others I apologize for not mentioning and we wouldn't have been able to accomplish all that we have without this, and for this I am very grateful.

The around the clock efforts of many of the Sahana community are too numerous to mention here, and at risk of leaving anyone out, I would just like to thank everyone for all that they have done and been able to do while juggling responsibilities such as full-time jobs and families.

This has been a new model for Sahana deployments - rather than waiting for a specific customer to come forward to take ownership of Sahana, we have self-deployed and I think this will be a likely successful model for the future. More and more, technology projects are stepping forward and doing good directly.

So go forth and do good.

Best regards,
Mark Prutsalis
President & CEO
Sahana Software Foundation

Saturday, January 16, 2010

Compass-ion and care cartography

Are you a -

Care surveyor?
Care commissioner?
Care architect?
Care assessor?
Care appraiser?
Care philosopher?
Care manager?
Care publicist?
Care gatekeeper?
Care journalist? Care mentor? Care ecologist? Care informatician?
Care provider?
Care student?
Care planner?
Care archivist?
Care governor?
Care wright?
Care cartographer?
or is that - Care mapper?

or just a -


What c+mpass do you use to navigate the CARE -

dialogues, records, policy, IT systems,
outcomes ...

Wednesday, January 13, 2010

'situated' in Hodges' model #2

So, Hodges' model is person-centred and situated
- a conceptual springboard for all.

In the 1970-80s the nursing process challenged task-based care.

Ever since we have stressed individualised, personalised care and now today self-care.

Interpersonal and communication skills are central to nursing theory,
practice, management and informatics.

In Hodges' model the individual is the primary focus*.

The science and art of nursing
is predicated upon the
nurse - patient

Situated = 'Its a duet' (anagram)

*Inclusion of the 'group' in the model also facilitates
consideration of relatives, parent-child, family, community and populations.

Tuesday, January 12, 2010

'situated' in Hodges' model #1

I'm not exactly sure how many times I've cut and pasted the paragraphs that introduce Hodges' model as person-centered and situated. Quite a few!

Thanks to the HIFA-2015 list I realised last week that there is no tag for 'situated' on W2tQ. Well, this post corrects that omission, but what does situated mean in Hodges' model?

Here is a definition c/o Google:

  • situated/s'ɪtʃueɪtɪd/
    • If something is situated in a particular place or position, it is in that place or position. ADJ adv ADJ v-link ADJ prep
Related phrases
  • If you situate something such as an idea or fact in a particular context, you relate it to that context, especially in order to understand it better.
Hodges' model is based on the belief that health and social care are multicontextual. Without wishing to substitute one term for another context and situation are inter-related and bear closer examination here on W2tQ.

Hodges' model prompts the user to consider that the person (-at-the-center) of care is simultaneously residing within four primary situations or contexts (five - if we include the spiritual aspects). Veterans and new recruits appreciate from the dizzy heights of the model, how quickly we find complexity in the multiple contexts that exist in health and social care. The many perspectives and views that must be taken into account to achieve safe, integrated and holistic care. Together with the above there are other definitions of relevance to scholars, champions and users of Hodges' model:
located: situated in a particular spot or position; "valuable centrally located urban land"; "strategically placed artillery"; "a house set on a ...

In artificial intelligence and cognitive science, the term situated refers to an agent which is embedded in an environment. ...

Located in a specific place; Supplied with money or means
The first definition about location is important as Hodges' model puts the person at the center. It is from there that the care domains are considered in turn and revisited as required. Hodges' model provides a locus around which care activities can be placed. Usually we view self-centeredness in a pejorative way. When you think about it though this is precisely what is needed to achieve person-centered care. In this case we need something that constantly re-centers - reorientates the subject(s) and agent(s) of care.

The second definition which looks to A.I. for inspiration is relevant as the concept of embodiment, embeddedness already has academic form* as a means to explore self-centeredness. Not only is the individual embedded in a (the) situation, but the carer (formal - informal) must also reside there and share to an extent the experience, if empathy, rapport and communication are to arise.

That final definition can be utilised due to the inclusion of means. People have skills, strengths and coping strategies and this sense of situated rings very true at present, with the emphasis on recovery, staying well, relapse prevention and adjusting to what may be permanent change. People also need knowledge as a means to maximise their health and well-being, which takes me back where I started with Health Information for All by 2015.

So, amid all the complexity, over-arching infrastructures, policies,
debate (and definitions!) it is refreshing that as I revel in the
scope of Hodges' model - two axes, four domains,
its holistic bandwidth... I can find the
word 'situated' planted
at the model's

* Ref:
Paley, J. (2004) Clinical cognition and embodiment, International Journal of Nursing Studies, Volume 41, Issue 1, Pages 1-13.

Image source - with thanks: Ariel Bravy - http://www.arielbravy.com/photoblog/

Monday, January 11, 2010

Ticks in boxes and triplicate thinking

Having things in triplicate may be reassuring from an admin perspective. ...

Triplicate GirlThat said, 1st year learners on wards can relax to focus on learning, not having to worry (too much) about the administration - the running of the ward 24/7.

Very soon though years 2... 3 come knocking and they must consider due process, they have to question and get to grips with the established routine that sets and keeps several plates spinning.

Of course IT has by and large (?!) removed the need for paper carbon copies (although those three copies should have three distinct purposes).

Despite that an obsession with ticks in just three boxes may not be enough when it comes to high quality multidisciplinary, holistic and integrated care - it's ticks in the mind and attitude that count.

Additional links:
Records Management Society

The Productive Ward

Image source:
Triplicate Girl - http://upload.wikimedia.org/wikipedia/en/6/63/Triplicate_Girl_LSH3.jpg

Thursday, January 07, 2010

Comment on Paul Roemer's "EHR market is ripe for the taking by Google, Microsoft, Oracle"

I read with great interest Paul Roemer's post last month -

EHR market is ripe for the taking by Google, Microsoft, Oracle

I've a lot of respect for the people working at that other sharp end of health. There are times when they are where I would like to be: not the bleeding edge, but the business edge:

Paul is a healthcare strategist and the managing partner of Healthcare IT Strategy, which helps health care providers solve business problems using EHR, workflow improvement, and change management.

Mr Roemer is out there among the corporations, the deals, the media frenzy and the stock market's take on health care AND health IT. He is addressing specific audiences and over here in the UK we can hear the debate raging. My problem is that working for the NHS all my career I have been and am cocooned. Even though I try to venture out and get involved, this is the very powerful criticism of long-term public sector employees. While far from totally sheltered from economical and political climate change, we are protected from the worst of the business elements. Despite this, seeing the title of Paul's post and his two rules:
Rule No. 1: Content is king. In cable, it is channels such as HBO and Discovery. In healthcare it is data--patient data, effectiveness data, disease data.
Rule No. 2: The cable/telco model values the businesses based on the number of assets (subscribers--you and me). Each body adds somewhere between $5,000 and $10,000 to the valuation model of a Comcast or a Verizon. Downstream, some valuation will be placed on each PHR subscriber.
- two additional rules sprang instantly to mind. ...

Rule 3: Beware low hanging fruit

I posted in April 2009 Data sharing, privacy, health, citizenry.... "Database State" expressing concern that the sanctity of personal data is being eroded bit-by-bit in the mind of the general public by the media and the sheer ubiquity of information and technology. Peaches, plums, pears are delicious when ripe, but as such they need to be handled very carefully. So too does the Personalised health record amid a variety of threats - the worst of which are often internal. In health care the patient data that Paul identifies in his Rule 1 is central, and a key issue is the demarcation of individual and anonymised aggregated data. Hence, Paul quite rightly points to a regulated market. Personal data can be far more valuable in terms of direct marketing and so the temptations for misuse are profound.

In the UK an NHS consultation has addressed the additional uses of patient data. This concerned the research capability programme and provision of a health research support service; with events to present proposals and debate the various issues that include information governance....

Information governance is not fixed, nor should it ever be.

In Paul's rule 1 content is king and content=data - in this case:
  • patient data;
  • effectiveness data;
  • disease data.
This list of data would surely qualify as being 'broad spectrum' in nature. If its circulation is not very tightly controlled it can damage the (care) environment. If not managed effectively across multifold 'borders' - national, regional/state, corporate, systems, organisations, users, testing, interfaces, legislative, public bodies - this data can mutate markedly despite the insistence upon standards. You see although Google, Microsoft and Oracle may take that ripe fruit, as they pick it they come across -

Rule 4: Whenever and wherever picked,
fruit can be tainted

This might include the odd bug, or one or two tainted fruit items perhaps? It could be problems in the form of parts of the EHR that are difficult to incorporate, with questions of shared access and ownership? If the fruit is indeed pristine, no blemish, no chemicals, no truly-devoted-insect-kisses: what are the overheads with this particular harvest?

If Google, Microsoft and Oracle believe they can do an Indiana Jones and just shoot to solve the problem because, as Paul suggests, they have the 'numerics' in the cable/telco model, then they need to take care (even if only improvising).

Microsoft, CSC and many other corporations already know of the complexity that reigns (pours in fact!) from their experience in health IT. Paul highlights Google as a new kid in town. Maybe acquisition does obviate the need to learn quickly (let others learn the lessons). But whatever the point of entry: health care (IT) remains a cussed business. And the future mix demands (begs!) the integrated addition of social care, but how and to what level?

It is not enough to counter "let's attack this complexity with simplicity." Health and social care are metronomic. They alternate between complex - simple descriptions (one of which is re-organisation). Plus, that metronome may as well be in a closed box:

Its owner is one Mr Schrodinger.
Care to gamble?

Paul's post is also fascinating since predictions about subscription numbers do count and speak volumes (sorry - but they really do). They will not only reach shareholder's ears, but when the model takes off - the general public's too. This could help erode the cherished sanctity of my personal data. So am I saying that some of the giants of corporative intelligence turn and run screaming, arms raised like surprised Martians in alien territory? No.

Maybe, as I have found -

the real low hanging fruit is the m+del.

Is it as ripe and appropriate in this market as it seems?
Or is it past its sell by date?
Time as ever will tell.

Additional link: NHS data breaches: the 'cogeography' of who and where?

Image source:

=============== Paul's Post Follows ==============

December 17th, 2009
by Paul Roemer
The national EHR market is ripe for the taking by a big three like Microsoft, Google and Oracle. Heck, I'll even go so far as to suggest that when the dust settles in about five or seven years, the National Health Information Network will be a regulated combination of a handful of those firms.

As for the other firms offering or planning to offer PHRs, permit me to suggest the following scenario: Let's say I am in charge of Google's somewhat non-existent healthcare line of business. One of my goals would be to have more users of my PHR than any other firm.
Why does this model make sense? Two ways, both of which come from the cable/telco business model.
Rule No. 1: Content is king. In cable, it is channels such as HBO and Discovery. In healthcare it is data--patient data, effectiveness data, disease data.
Rule No. 2: The cable/telco model values the businesses based on the number of assets (subscribers--you and me). Each body adds somewhere between $5,000 and $10,000 to the valuation model of a Comcast or a Verizon. Downstream, some valuation will be placed on each PHR subscriber.
So, back to the example of me running Google's healthcare offering. (If you don't like Google as an example, insert your favorite firm.) If I'm Google, am I troubled by the fact that other firms are building their own solutions? No, because the difficult part of the business model is adding users, adding subscribers. Why not let a bunch of firms do the business development work for me, do the dirty work to get the users, and then just devour those firms? Once I own them, I convert them to my platform. Do I then get some 'ownership' or right to use the data? That would certainly be the business goal.
One million users valued at $5,000 adds $5 billion in valuation. Ten million adds $50 billion. Ten billion is about 2.5 percent of the U.S. market. Do I stop at the border? Of course not.
By the way, while all this is going on, Google, Microsoft, or some other company will also be creating standards and building or buying up EHR firms.

Wednesday, January 06, 2010

BBC R4 Friday 8th Jan: NHS Punters Speak Out

This programme (episode 1) is on BBC Radio 4 on Friday 11.00:

With the help of dissatisfied NHS patients, Liz Barclay asks if the growing popularity of online feedback can really make a difference to standards of health care and treatment.
The culture of customers offering brickbats and bouquets to service providers has now extended beyond hotels and coffee chains to the NHS. Hospital rating websites invite patients to grade their hospital stay out of five stars, and to leave comments about the care they received.
Liz invites NHS patients who have used one of these patient rating websites to discuss their experiences and puts their points to the hospitals where they were treated.
She asks if the idea of online feedback can be really be applied to our health service and if it can genuinely improve standards of care. Critics suggest the sites are merely window-dressing and that NHS patients are not 'consumers'. Some health professionals claim that the sites can easily just become places where personal scores are settled against NHS staff.

Introductions to Hodges' model for different audiences -

(person-centred care)
Health, Social Care professionals
(inc. all in a student capacity)
The Public, CitizensManagers, Policy Makers

These introductions will be re-written for the new website and represent possible projects for volunteers / students...?

Tuesday, January 05, 2010

Your odds on favourite: Hodges' model


The Hodges-Jones Classic Integrated, Holistic &
Multidisciplinary Care Chase

Going: heavy
26m 1.75f



2HARD SCIENCEEvs10-115-610-115-6

Additional links:
Gamblers Anonymous


Gambling Commission

Inspired by BBC News and living by Haydock Park Racecourse

Ref info:

Saturday, January 02, 2010

Sun Microsystems blog: Pretty good example* of a Strategic (Design) Brief

The Sun Microsystems site includes a blog (Martin Hardee) with an article entitled as above that poses eight questions. These questions can greatly inform the process of creating a strategic brief (which is also provided for download). Although the item is from 2005 and the context differs - contrast a corporate website design and a future website for Hodges' model - there is value for me in answering the questions. So here goes... starting with the opening paragraph from the original blog post then the questions in bold, interspersed with my responses:

As I've mentioned in previous postings, the most important single step you can take in designing anything for the web is to create a strategic brief. This should be done early in the discovery phase of any design project. The reason it's so important is that it will make you focus and it will provide a guide map for whoever is creating and implementing your design. To write a strategic brief, you'll need to know a lot of important but oft-ignored basics such as:
A) Why are you embarking on this design (or new web site, or whatever), anyway?

The existing website was created in 1997 using Hot Metal Pro and written in HTML. The site was built as a personal and spare time project around the original course notes of Brian Hodges. These were in the form of Word files produced with secretarial support as part of a Post Graduate Certificate of Eduction project. As a result the current website has developed in a rather ad-hoc manner, with the addition of pages on informatics and information. The home page was re-designed in 2005 using Fireworks (Adobe) reflecting the model for which it is 'home'. At no point thus far has the website provided a community for users of Hodges' model. The site is currently static, without a database to support dynamic content development and a community of users.

Use of Drupal will provide a (truly) dynamic lever by potentiating the following:
  1. sheer unadulterated enthusiasm and fun (lifelong learning - literacy skills);
  2. a more professional footing (hosting...);
  3. international customisation (multiple languages);
  4. ultimately address several audiences (health, education, informatics and public);
  5. find out what would-be users of the model want;
  6. create some consistent styling;
  7. provide an archive;
  8. building on the foundation provided by the website and this blog W2tQ;
  9. provide a foundation for future research (by producing my 1st Drupal site - a beta);
  10. (As already noted I have wondered about linking this project to a research course, but at the moment I ask myself what's the point...?)

B) What are your business objectives and how would you measure success?

There are no 'business objectives' as such, but if this blog and a future site can generate some revenue to support purchase of hardware, (some) software and services then "that's about time". General objectives are to generate critical thinking and decisions on:
  • content types to support the use of Hodges' model;
  • phased development;
  • interface design - use of Ajax, jQuery.
Ultimate (reach for the stars...) objectives:
  • to invite users to contribute to the model's development;
  • reopen the question of visualization in the social sciences;
  • to learn of other conceptual frameworks that might also support 'global health for all';
  • to produce a virtual learning environment that conjoins health, informatics and education;
  • to influence nursing curricula development;
  • to create a self-sustaining global community of users
  • to cover some costs and let go. ....

C) Who are your various audiences or customer segments and what are their objectives (often different from your business objectives, btw)

+ students (health and social care);
students (generic - PSHE);
all qualified care professionals
+ lecturers

The objectives here are diverse, but include completion of learning and course tasks, including essays and case studies, tools to support and demonstrate reflection and holistic / integrated care in theory and practice. Lesson plans and means of assessment are also essential, to what extent can students and professionals - indeed all users of a conceptual framework demonstrate - competency? This has to be through specific assignments and marked assessment which could include:
  1. essay;
  2. case study;
  3. oral presentations, audio, video podcasts;
  4. quizzes, e.g., multiple choice;
  5. and possibly specific 'roles' through the Drupal site.
The politics of the educational establishment include that tools should be evidenced, safe, fit for purpose. There may also be a requirement to dovetail with use of dedicated learning management systems and standards such as SCORM. As such a new site should seek to incorporate such standards - through Drupal - in so far as they do not affect innovation and projecting the model into the future.

+ patients and carers

Patients and carers would often benefit from a means to facilitate dialogue with their keyworkers and the associated health and social care team. Hodges' model can help provide a schema, portal and media form for such dialogues. This dialogue can potentially act as:
  • an aide-mémoire for the patient during a Consultant appointment (maximising the time available for both parties);
  • a means for educational engagement (medication concordance, relapse prevention....).
+ policy makers and care commissioners
+ managers

These stakeholders are concerned with metrics, outcomes, quality and evidence.

+ information and communication technology staff

In addition to project management tools ICT staff would benefit from tools that support socio-technical perspectives.

For all the would-be users of Hodges' model the critical question is evidence. The new site should provide a foundation for research in Hodges' model and other conceptual frameworks.

D) What's the scope: How much are you going to tackle at once?

By using a content management system Drupal provides a means to be more productive (once sufficiently skilled!) in terms of addressing the objectives and scope delineated above.

This is the key question!

I need to acknowledge advice already provided from friends at the Drupal NW England group and Ruby community. Basically - do what you need to to get a site out of the door. What I must identify is the baseline functionality and design that will provide the foundation for a site. The baseline must include:
  • roles and access rules;
  • at least one specific content type (whether existing or new) for Hodges' model;
  • RDF;
  • accessibility.

E) What sort of constraints do you have in terms of product, business process, technology, or budget?

Hodges' model is nebulous and grand in its potential scope so it is vital that constraints are imposed on the project. A new PC and software will prove a great advantage leaving behind a trusted 7 year old machine. There is a no dedicated budget for the project.

The biggest constraint is time. This is non trivial and has already impacted this blog in that the comments are disabled. Early on the comments facility invited spam.

F) What existing projects and groups does this project need to coordinate with in order to avoid a train wreck?

None. The only legacy commitment are to move the existing pages to an archive that is readily accessible and signposted.

There are however two considerations:

1. Since first identifying Drupal as the platform to adopt, it was at version 4.7. It is now on the brink of version 7.0. This dynamic development environment presents challenges of its own.

2. As already highlighted if the new site is to reach the educational community it will be necessary to take heed of existing Drupal modules and resources, e.g. the DrupalEd distribution, The Scientific Collaboration Framework and assess their suitability - 'off the shelf'.

G) What kind of market and "voice of customer" research (including site metrics) do you already have?

In ten years with the existing site evidence shows that people do not have time to 'get in touch'; more needs to be offered. The existing website is 'failing' in terms of:
  • as stated its dated design;
  • site metrics - hits;
  • publishing standards (academic, relevance, timeliness and currency, referencing, styling, semantic markup);
  • and user engagement.
Despite the non-trivial constraint of time and website 'stasis' this blog is an emerging as a potential channel of engagement. The clustermaps and recently added 'flags of the world' demonstrate the global appeal of the content here and hopefully the model. Since there is little time for analysis of Google analytics data, the new site will utilise core statistic functionality and contributed modules as available (and proven).

H) What are the roles on the project? For instance, if you're engaging a design vendor what are they delivering vs. what are you delivering to the final mix?

As per the existing site and given budget constraints (i.e. there is none) there are no 'roles' on the project. All are up for grabs and presently rest with me. Hence the appeal of a content management system (Drupal) to ease the design and development burden.

Additional links:

Sun Microsystems blog post:


* The good example here is the title of the Sun Microsystems article and not necessarily my answers to the questions.

Image sources:
Drupal Groups
Chess piece:

Friday, January 01, 2010

"2010" definitely not - future vision is 20:20!

Happy New Year everyone!

Janus: Eric SuticAs 2010 begins with the first day and month of January I always think of Janus and the origins of January as per the description on Wikipedia:
In Roman mythology, Janus (or Ianus) was the god of gates, doors, doorways, beginnings and endings. His most prominent remnant in modern culture is his namesake, the month of January, which begins the new year. He is most often depicted as having two faces or heads, facing in opposite directions.
Looking to the past and future my eyesight has proved a another source of personal upheaval. In September 2008 I went to get some new specs as I knew all was not well. I thought I was just tired, making excuses for a new pair of glasses and eyes that could still not focus. I went back in January '09 to learn I had a triplopia. After the first op (left eye) I realised how bad my right eye remained.

Picking up a white mug and using the lens mother nature gave me I was shocked to see a green-yellow cast over the mug. I have been able to type online and at work quite well and accurately by relying on my previously attained keyboard skills. Driving was becoming problematic, with traffic lights forming a perfect triangle. The lines in the middle of the road would float and merge in the distance. No wonder the optometrist asked me in July if colours seemed as vivid as they should be. I studied art at GCSE level and thought I had a good appreciation of the colour wheel and all that: Tch!

Now two eye ops later - left eye care of surgeon Mr Heaven and the right by Mr Mars (yes really) I have better than 20:20 distance vision with intraocular implants. I was reminded of younger years coming downstairs and the room looking so bright, as if it had snowed and then here in the UK it did snow.

Many thanks to Messrs Heaven and Mars and the team at Wigan Royal Albert Edward Infirmary (where I also did my general nurse training). They have done an excellent job!

Post an out-patient appointment in two weeks I will finally be able to sort some reading glasses.

If winter is a time for reflection well as per my final post of 2009 then I have reflected much of late, but at least I can see clearly now.

I hope you can too - especially if you are in a position of power and influence!

Take care wherever you are now and over the coming year ....

Image source:
Eric Sutic http://www.onecloud.nu/Visual/things/janus.jpg